Provider Demographics
NPI:1821259953
Name:HERNANDEZ, GERTRUDES AQUINO (PHD)
Entity Type:Individual
Prefix:
First Name:GERTRUDES
Middle Name:AQUINO
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:VIDA GERTRUDES
Other - Middle Name:AQUINO
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2815 MITCHELL DR STE 119
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-1622
Mailing Address - Country:US
Mailing Address - Phone:510-301-8655
Mailing Address - Fax:949-757-2537
Practice Address - Street 1:2815 MITCHELL DR STE 119
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-1622
Practice Address - Country:US
Practice Address - Phone:510-301-8655
Practice Address - Fax:949-757-2537
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23706103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL515AMedicare PIN